{$ERROR_MESSAGE}
<div class="form_container">
  <div class="form_container_center">
    <form id="trial_form" name="trial_form" method="post" action="" class="trial_form">
      <div class="information_row">
        <div class="name_field"><span class="required_pointer">* </span>Name:</div>
        <div class="input_text_field">
          <input class="edit_field" type="text" name="name" value="" />
        </div>
        <div class="error_field"></div>
      </div>
      <div class="information_row">
        <div class="name_field"><span class="required_pointer">* </span>Email:</div>
        <div class="input_text_field">
          <input class="edit_field" type="text" name="email" value="" />
        </div>
        <div class="error_field"></div>
      </div>
      <div class="information_row">
        <div class="name_field">Phone:</div>
        <div class="input_text_field">
          <input class="edit_field" type="text" name="phone" value="" />
        </div>
        <div class="error_field"></div>
      </div>
      <div class="button_row">
        <button type="submit" value="Continue" title="Continue">&nbsp;</button>
      </div>
    </form>
  </div>
  <span class="corner left_top">&nbsp;</span>
  <span class="corner left_bottom">&nbsp;</span>
  <span class="corner right_top">&nbsp;</span>
  <span class="corner right_bottom">&nbsp;</span>
</div>